Colorectal Cancer: Why You Need to Get Tested
Colorectal cancer is the second leading cause of cancer-related deaths among men and women combined—not just in the United States, but globally as well. Fortunately, there are tests that can detect colon cancer at its earliest stages and even prevent the cancer from turning into something serious.
Occurrence & Risk Factors
In 2018, approximately 150,000 cases of colon cancer were diagnosed, leading to about 50,000 deaths. Dr. Love Dalal, gastroenterologist with Oroville Hospital, is hoping to drive those numbers down with more awareness surrounding screening. “Colon cancer, once developed, has a good response to treatment,” he states. “If this cancer is not spread outside the colon, five-year survival is about 90 percent.”
Risk of colorectal cancer increases with age. There is also a genetic component, leading to some younger individuals falling victim due to genetic abnormalities. Other risk factors include obesity, diabetes, red meat consumption, and tobacco and alcohol use. African Americans are 20-25 percent more likely to develop the cancer over Caucasians.
The clearest warning sign that something may be amiss is rectal bleeding, which should be investigated as soon as possible by a gastroenterologist. That said, bleeding does not necessarily indicate cancer. “Anytime you experience rectal bleeding, it is abnormal,” cautions Dr. Dalal. “Hemorrhoids are the most common cause of rectal bleeding, but unless you get yourself checked, it is not possible for anybody to say it is coming from hemorrhoids and not from a polyp or cancer.”
Screening Methods & Guidelines
Colonoscopy is the most well-known screening tool, but other preliminary screening methods are available. “We always believe that patients should undergo some form of testing rather than no form of testing,” advises Dr. Dalal. “People tell us they are not willing to undergo colonoscopy because of various reasons, and we tell them to at least undergo a stool exam or an x-ray rather than not doing anything and sitting tight.”
Per the U.S. Preventative Task Force Guidelines, men and women should begin screening at age 50. The American Cancer Society came out with new guidelines in 2018, recommending that screening should commence at age 45 because an increasing number of the younger population are now diagnosed with colon cancer.
To clarify, Dr. Dalal states that colonoscopy is done for colon cancer screening as a preventative measure—not with the goal of finding colon cancer. “By colonoscopy, we are trying to locate colon polyps. In 90 percent of the time, colon cancer starts from a colon polyp. Hence, if you can remove a polyp, the chance of colon cancer is eliminated,” he explains.
Polyps are classified into five different types, one of which is not cancerous. Of the four other types, not all will turn into cancer. “The thing is, I have no way no way to tell just by looking at the polyp during the procedure, or even after removing them, which one was bad or which one was good. Because all look alike,” notes Dr. Dalal. “So, when we see the polyps, all polyps must be taken out and subjected to analysis.”
What’s Stopping You?
One of the biggest detractors from undergoing colonoscopy is the preparation required. However, newer prep methods are making that component less uncomfortable for patients. “The conventional prep, which we have been using for the last 25 years, involves consuming a gallon of liquid. If I have to describe it, it tastes like seawater or salt water—certainly not very palatable. That scares people off,” shares Dr. Dalal.
The newer preps involve smaller volumes, which is increasing acceptability. The downside is that some insurance companies are not covering them as options.
Prevention Strategies
Mitigating the risk factors for colon cancer goes a long way towards preventing the cancer from ever developing. Diet plays a significant role in prevention, and Dr. Dalal advises a nutritional regimen high in fiber, whether naturally through fruits and vegetables or via fiber supplements. “Ideally, people should take in 25 to 30 grams of fiber by mouth every day, and that will definitely give you some protective effect,” he notes.
Some data suggests sufficient amounts of folic acid, calcium, and vitamin D can also prevent colon cancer and daily aspirin is even being contemplated as a valuable prevention measure.
Of course, colonoscopy should also be considered in one’s prevention strategy. “As opposed to a screening tool like mammography, colonoscopy is much more beneficial in the way that it can prevent colon cancer by detecting and removing colon polyps,” explains Dr. Dalal. “If you are not willing to undergo colonoscopy, please select an alternative method and get yourself tested.”